The recruitment of EEA and non-EEA doctors to Specialist Registrar posts in anaesthesia in the Wessex Region of the UK: a retrospective study of factors influencing successful appointment

BACKGROUND AND OBJECTIVE

A retrospective analysis of applicants to Specialist Registrar training posts in anaesthesia in the Wessex Region of the UK was undertaken.

METHODS

Applicants whose primary medical qualification was obtained in the European Economic Area were compared to applicants whose primary medical qualification was obtained outside it. The time since qualification, the time spent in anaesthesia, the time spent in other specialities, the post currently held and the success of the application were recorded.

RESULTS

For doctors with a primary medical qualification from outside the European Economic Area, the median time since obtaining that qualification was 12.0 yr compared with 6.0 yr for doctors qualifying within it (P = 0.0001, U-test). Thirteen out of 89 (15%) doctors whose primary medical qualification was from outside the European Economic Area and 39 out of 61 (64%) doctors whose primary medical qualification was from within it were shortlisted for interview (P = 0.0001, chi2-test). Six out of 13 (46%) shortlisted doctors from outside the European Economic Area were appointed at interview compared with 24 out of 39 (62%) shortlisted doctors who qualified within it (P = 0.33, chi2-test).

CONCLUSIONS

In the Wessex Region of the UK, applicants whose primary medical qualification is obtained within the European Economic Area are approximately four times as likely to be shortlisted than doctors qualifying outside it. However, after shortlisting, both categories are equally likely to be successful at interview.

Anaesthetic management of the Kenny-Caffey syndrome using the laryngeal mask

We report the anaesthetic management of a nine-year-old, 6.8 kg, 75 cm tall female with the Kenny-Caffey syndrome presenting for strabismus surgery. Dysmorphic features in our patient included a hypoplastic mandible. A neonatal (size 1) laryngeal mask was successfully used for management of the airway whilst providing surgical access. The general features of this rare syndrome are presented and the literature reviewed.

Vomiting after outpatient tonsillectomy and adenoidectomy in children: the role of nitrous oxide

The role of nitrous oxide anesthesia in causing postoperative vomiting (POV) was studied in 60 children undergoing outpatient tonsillectomy and adenoidectomy. In this controlled, randomized, double-blind investigation, anesthesia was induced by inhalation of a volatile anesthetic in both groups. The nonnitrous oxide group received no nitrous oxide, even during induction of anesthesia. Designated nurses in the postanesthesia care unit (PACU) who were blinded to the anesthetic technique evaluated the incidence and the severity of the patient's emetic symptoms, both in the PACU as well as after discharge. Pharmacologic intervention was administered on the basis of evaluation by the nurses. Although a high incidence of POV was noted in both groups, there was no difference in either the incidence or the severity of POV between the group receiving nitrous oxide and the group receiving no nitrous oxide.

Effect of nabilone on nausea and vomiting after total abdominal hysterectomy

In a prospective, double-blind study, we have examined the effect of preoperative nabilone on postoperative nausea and vomiting (PONV). Sixty women, less than 70 yr old, undergoing total abdominal hysterectomy, were allocated randomly to receive either nabilone 2 mg or metoclopramide 10 mg orally 90 min before induction of anaesthesia. The study was designed to detect a 50% difference in the incidence of postoperative vomiting between the two groups, with an 80% power of achieving a statistically significant result at the 5% level. Data from 53 patients were analysed: the incidences of nausea and vomiting for the metoclopramide group were 70% and 67%, respectively; the corresponding values for the nabilone group were 73% and 54%. These differences were not significant.

Comparison of the analgesic and emetic properties of ketorolac and morphine for paediatric outpatient strabismus surgery

In a prospective, double-blind, randomized study, we have compared i.v. ketorolac and morphine in paediatric outpatients undergoing strabismus surgery. Forty-two ASA I or II children, aged 2-12 yr, were allocated randomly to receive either ketorolac 0.75 mg kg-1 i.v. or morphine 0.1 mg kg-1 i.v. and metoclopramide 0.15 mg kg-1. Anaesthesia was induced with propofol and maintained with propofol and nitrous oxide. Pain was assessed at 15-min intervals until discharge, and the incidence of nausea and vomiting was recorded for the first 24 h. There was no difference in pain behaviour scores or recovery times. The incidence of nausea and vomiting during the first 24 h was 19% in the ketorolac group and 71% in the morphine group (P < 0.001). We concluded that ketorolac was an effective analgesic for this type of surgery and that it was associated with less postoperative emesis than morphine and metoclopramide.

Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery

A prospective, randomized, double-blind study was conducted to examine the effect of a propofol infusion on the incidence of postoperative emesis in children undergoing outpatient strabismus surgery. Seventy-eight children, aged 3-12 yr, were allocated randomly to receive either nitrous oxide and halothane or nitrous oxide and a propofol infusion for the maintenance of anesthesia. The overall incidence of vomiting during the first 24 h was 64% in those receiving halothane and 41% in those receiving the propofol infusion; this difference was statistically significant (P < 0.05). In children who received no opioids postoperatively, the incidence of vomiting in the first 24 h was 71% in the halothane group and 24% in the propofol group; this difference was also significant (P = 0.001). We conclude that propofol was effective in reducing the incidence of postoperative emesis in pediatric outpatient strabismus surgery.

Upper respiratory tract infections and general anaesthesia in children. Peri-operative complications and oxygen saturation

Conflicting reports regarding the hazards of anaesthesia in children presenting for surgery with an upper respiratory tract infection have appeared in the literature. In the present study 130 children undergoing general anaesthesia with face mask for myringotomy and grommet insertion were graded as having either an acute or recent upper respiratory tract infection or were asymptomatic according to predetermined clinical symptoms and signs. The severity of respiratory and related complications were scored during induction, emergence and recovery. The peripheral oxygen saturation was recorded during induction, emergence, transfer to the recovery ward and in the recovery ward itself. There were no significant differences (p greater than 0.05) in the complication scores between the three groups of children. However, the incidence of hypoxaemia (oxygen saturation less than or equal to 93%) was significantly greater during transfer in the acute infection group (p = 0.001) and the recent infection group (p = 0.02), as well as during recovery in the acute group (p = 0.03) compared with asymptomatic children.

Recovery from day-case anaesthesia: comparison of total i.v. anaesthesia using propofol with an inhalation technique

A prospective, double-blind study was conducted to compare postoperative recovery after either total i.v. anaesthesia (TIVA: propofol and alfentanil) or an inhalation technique (propofol and alfentanil followed by nitrous oxide and isoflurane) in 50 patients undergoing day-case gynaecological surgery. Psychomotor performance was assessed at 1 and 2 h after surgery using the Critical Flicker Fusion Threshold (CFFT), Simple Reaction Time (SRT) and Choice Reaction Time (CRT). Subjective recovery and side effects after discharge from hospital were assessed using a postal questionnaire. Recovery occurred significantly earlier in the TIVA group as assessed by CFFT and SRT (P less than 0.01); there were no significant differences (P greater than 0.05) between the two groups in CRT, subjective duration of recovery or side effects.

Effect of P6 acupressure on postoperative vomiting in children undergoing outpatient strabismus correction

A prospective, double-blind study was conducted to compare the effect of pressure at the P6 (Neikuan) point with placebo as an antiemetic in children. Sixty-six patients, ages 3-12 yr, undergoing outpatient surgery for correction of strabismus, were allocated randomly to receive either bilateral P6 acupressure or placebo during the perioperative period. The study was designed to detect a 50% difference in the incidence of postoperative vomiting between the two groups, with a 90% power of achieving a statistically significant result at the 5% level (two-tailed). The incidence of postoperative vomiting for the placebo group was 58% before discharge from hospital, 73% at home and 82% in the first 24 h after surgery. The corresponding results for the acupressure group were 58% before discharge, 71% at home and 94% in the first 24 h. These differences were not significant; P6 acupressure did not reduce the incidence of postoperative vomiting in children undergoing strabismus surgery.

Anesthesia and mental illness

Although drug interaction probably remains the most potentially serious problem, current evidence suggests that psychiatric medication need not be discontinued prior to anesthesia and surgery, discontinuation of medication may constitute its own hazards. Most interactions can be predicted and appropriate precautions taken, the use of meperidine is now absolutely contraindicated for patients receiving MAOI's.